Transcript Seven Year Experience of Race on Selective Laser Trabeculoplasty

Effect of Race on Selective Laser Trabeculoplasty
ASCRS 2011
Matthew B. Donovan
University of Miami
Michael Mishali
Elaine M. Miglino
Lawrence F. Jindra, MD
Adelphi University
Floral Park Ophthalmology
Columbia University
Winthrop University Hospital
1st author has no financial interest in the subject matter of this poster.
 2nd and 3rd co-authors have no financial interest in the subject matter of this poster.
 4th co-author has independently conducted and financed the clinical research study presented herein and has received honoraria from Ellex Corporation in the last year.
Introduction

Selective Laser Trabeculoplasty (SLT) uses a Q-Switched frequencydoubled (532 nm), low energy Nd:YAG laser, which targets melanocytes in
1,2
the trabecular meshwork .

SLT treatment induces a biologic response in the trabecular meshwork,
which involves the release of cytokines that trigger macrophage
recruitment and other changes, leading to reduction in intraocular
pressure (IOP).

SLT treats the trabecular meshwork without causing thermal nor
coagulative damage to surrounding structures.
1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions.
Exp Eye Res. 1995;60:359-372.
2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot,
clinical study. Ophthalmology. 1998;105:2082-2090.
Purpose
 To examine the effect of race on Selective Laser
Trabeculoplasty (SLT), as primary or secondary
therapy, to decrease intraocular pressure (IOP) and
reduce the number of medications (meds) used in
patients with glaucoma.
Methods
 Retrospective chart review was performed on 2,002 of 3,034 eyes
from a continuous case series of eyes treated with SLT over 8 years.
 Eyes were grouped according to therapy method (primary or
secondary) and race (Black or White).
 Post-SLT IOP decrease and reduction in meds were analyzed.
 Two-tailed paired t-test was used to compare maximum pre- and
average post- procedure IOP and meds.
Results: Primary
Race
N-Value
(eyes)
Mean
Follow-Up
(days)
Mean
IOP Decrease
(mmHg)
Mean
IOP Decrease
(%)
Black
135
958
6.2
32%
White
1078
774
5.8
31%
 No significant difference in results (p > 0.05) for mean decrease in IOP
Results: Secondary
Mean
Mean IOP
Follow-Up Decrease
Days
(mmHg)
Mean IOP
Decrease
(%)
Mean
Reduction
in Meds
(meds)
Mean
Reduction
in Meds
(%)
Race
N-value
(eyes)
Black
137
489
5.0
18%
1.3
58%
White
652
598
4.0
18%
1.3
68%
 No significant difference in results (p>0.05) for mean decrease in IOP.
 Significant difference in results (p<0.05) for mean reduction in meds.
Discussion
 The Glaucoma Laser Trial
• Established efficacy of laser trabeculoplasty in lowering IOP in previously
1
untreated glaucoma patients .
 The Ocular Hypertensive Treatment Study and
 Early Manifest Glaucoma Trial
• Established efficacy of early and effective treatment to preserve long-term
2,3
visual function in glaucoma patients .
 Our findings build on these and suggest that as a result of race, after treatment
with SLT there was no significant difference in IOP decrease; reduction of the
number of meds used was significantly greater in white eyes.
 Further study with controlled clinical trials is indicated.
1. The GLT Research Group. GLT. Ophthalmology. 1990;97:1403-1413.
2. Kass MA, et al. OHTS. Arch Ophthalmol. 2002;120:701-713.
3. Heijl A, et al. EMGT. Arch Ophthalmol. 2002;120:1268-1279.
Conclusion
 In this large, long-term clinical series, there seems to be
no effect of race on Selective Laser Trabeculoplasty, as
primary or secondary therapy, to decrease intraocular
pressure; when used as secondary therapy, SLT
significantly reduced the number of meds used more in
white eyes, in patients with glaucoma.